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Author: DavidMizrahi

Ola! It has been a while since I have posted last, and as much as I would like to say it’s because I was busy training for a marathon, this is not the case. I’ve been getting stuck into a new job and writing research papers that I’ve worked on over the last few years. I will be going through my papers in the next few weeks to provide not just motivation, but scientific evidence behind why it is safe and beneficial to exercise during/after treatment.

So I thought I would start with a link to an article I was asked to write for the Oncology Newsletter about my experiences promoting physical activity for women with ovarian cancer who were undergoing chemotherapy. (Click the link below!)

* I have started a job at the Kids Cancer Centre at the Sydney Children’s Hospital, where I run clinical trials for kids with all sorts of cancers. We are also working on a few lifestyle projects to increase activity of kids during and after treatment (as there is early evidence that it helps the kiddies too!)

(oh, here is the day I got to dress up as Batman for Superheroes day, where the entire hospital staff dressed up!! I think I had just as much fun as the kids!)

* My thesis works were finally published! I was able to get my two main studies published in the International Journal of Gynecological Cancer (which I’ll discuss in subsequent posts), which gave me some sleepless nights, but it is great to get word out there of what the amazing ladies in my studies were able to achieve

!

* Always trying myself to get out and keep fit whether its playing soccer or touch football. I try to run for 40-50 minutes from time to time and I even went for a 15km cycle for the first time in 5 years on the weekend! I was slightly uncoordinated but it was still great fun!

Remember to aim for the American College of Sports Medicine’s 150 minutes/week of moderate intensity exercise i.e. getting your heart rate up a bit from a challenging activity

* Lastly, I have also gotten back into music, which I love playing the drums and it is a great outlet for me. I have joined the Kids Hospital band and we are working towards a range of fundraisers to come up in the next few months, as well as playing for the kids in wards when I’m able to.

So I really look forward to getting the website and community back up and active. I encourage you to share a personal experience with your exercise journeys and ask any questions that you may have. Please share this with somebody you feel could use the encouragement and as always, keep moving forward, one step at a time!

Stretching is essential for many reasons in maintaining health & wellness. It can be done by anyone, at any time – and is very easy to do, and it is alright if you are unsure as I will show you how in this post. In general, the main benefits attained from stretching include:

Increased flexibility or Range of Motion (ROM)

Reduced likelihood of injury

Improved benefits when completing aerobic & resistance exercise

Before I go on, I would just like to let you know, I have created a new Facebook page called Exercise Cancer Community: Health & Wellness, to create a supportive environment for people to share their experiences. Please visit the page, click the Like button on the side of this page or on the FB site and pass it on.

Now, stretching is important for basically anybody to maintain or improve their physical health, but it is particularly important for cancer survivors who have undergone treatment such as a surgery. For example, women with breast cancer who have undergone a mastectomy tend to experienced reduced should flexibility, strength & mobility due to muscle and tendon tissue damage. In fact, here is a great article by Dr Robert Kilgour displaying that home-based stretching can assist in reversing these results, as published in the Journal of Breast Cancer Research Treatments. By engaging in stretching exercises (and eventually resistance training exercises), you will be able to achieve a level of health pre-surgery, or even greater. But if not, simple daily tasks around the house such as reaching into cupboards above the head, discomfort whilst driving or picking up a baby may become challenging.

Here is an example of a “spider-crawl” or “wall walk”, where you slowly raise your arm up the wall to the level of your range (not to pain)

Before I show you individual stretches, here are the guidelines for stretching:

Stretches can be done daily or most days of the week (can do them up to 3-5 times/day)

Hold each stretch for 15-30 seconds

Repeat each stretch 1-3 times on each side

Have a deep breath in when commencing the stretch

Only complete the stretch to the full range of your joint (and not to a painful point)

Stretching is most effective when the muscles are warm, so after a walk is perfect

Here we go: If you are only a few weeks post surgery (1-3 weeks), you may consider doing “range of motion” exercises, that is just moving your joints to their point, and not pushing further.

Above: Shoulder flexion & extension

Above: Shoulder abduction

If these are simple, then lets move on to more stretches for the upper body:

Chest stretch:

Arm at 90 degrees against a wall, with forearm on the wall

Rotate body away from wall & hold

Shoulder stretch:

Arm across the body

Other hand presses the elbow closer to the body & hold

Triceps stretch (only if your flexibility allows you to do so):

Arm above and behind your head, with elbow in the air

Hand above your opposite shoulder

Using your other hand, pull the elbow across your body & hold

Biceps & forearm stretch:

Arm directly in front, with fingers facing downwards

Using opposite hand, pull the fingers back & hold

Do you see how simple some of these are? Definitely can be done at the office, in an elevator or at home! I constantly will be doing stretches to help aid my training sessions in the gym and at soccer around the office. Now here are some lower body stretches to do for the lower body:

Calf stretch:

Place hands on the wall

Take a step backwards with one leg, with foot placed flat on the ground

Bend the front leg, straighten the back leg and feel the stretch

With both feet flat, act as if you are trying to push the wall down. You should feel this in the back of your behind leg

Hamstring stretch:

(seated or on a yoga mat) put one leg out as straight as you are able to

Lean towards your foot, with your hands together

Aim to keep your back straight

Point your toe backwards for a greater stretch

Resistance bands can also be used for a greater stretch

If less mobile, use a chair for support

If you are more mobile and have progressed your flexibility, try a greater stretch using a resistance band

Quadriceps stretches:

Find a stable object for support (wall, table, exercise bike!)

Grab your foot of the leg you are stretching

Keep legs in-line with each other and pull until you feel a stretch

You can also use a resistance band or rope around your foot to assist if you have limited flexibility

Remember, every day you can partake in stretching, and before you know it, you will be improving your flexibility in no time. Combine this with your aerobic and resistance exercise and you are on your way to achieving a fantastic lifestyle.

Keep up the great work and please remember to provide encouragement to those in need, pass this resource on and keep continuing to send me questions and personal experiences.

Resistance training, or strength training utilises muscle contractions to build up strength by repeating the movements. Particularly during and after cancer treatment, you generally lose a lot of muscle strength and do not return to pre-existing levels. Think about where you used to be. Building up strength with resistance training will assist in getting you there. There are numerous benefits when completing strength training programs that have been shown in exercise-oncology studies and some of these have been listed as:

Strength training also does not need to be in a gym, which is a common off-putter for a lot of the general population, but everybody is different. If you have access to weights in a gym, I definitely recommend participating in a weights program, but if not, I have written this post to demonstrate that strength training can be safely and cheaply completed in the comfort of your own home.

The above video introduces the use of resistance bands, which can replace expensive weights (and can also travel on holidays with you! I did this on my tour of the United Kingdom!!). Depending on your strength levels, you can start on a light band, and work your way up to the more challenging ones, and they often come in packages which is good for when you get stronger – here is a link I found to purchase resistance bands but there are plenty more types on sites like Amazon.

I have also put together examples of strength training exercises using these resistance bands and body weight exercises, that assists in attaining the benefits offered by resistance training.

Strength exercises for the arms:

Strength exercises for the back:

Strength exercises for the chest:

Strength exercises for the legs (beginners):

and for advanced

So in a general rule of thumb, we will aim for around 10 repetitions for each set of exercises. You can do each exercise 2-3 times with a 1 minute rest in between which may give you a program that looks like this (and take approx 20-30 mins):

Exercise Repetitions Sets Rest

Sit to Stand 10 2-3 60s

Bicep Curl 10 2-3 60s

Chest press 10 2-3 60s

Standing row 10 2-3 60s

Tricep push 10 2-3 60s

Upright row 10 2-3 60s

And a basic summary for you all:

I put it to you, to give this simple, whole body program a shot, at least 2-3 times per week for the next few weeks and see how you go. Stand in front of a mirror so you can monitor your technique and compare to the videos.

After just a few weeks, you will be able to adapt, and rebuild your muscle strength that you may have lost with treatment. You never know, you may even be able to surpass your strength and ability from before your treatment. I have seen this first hand from some women in my ovarian cancer studies who loved doing strength training and made it a part of their normal weekly habits. They loved not having to rely on anybody else and able to partake in activities they had not done in years.

Let me know how you go!

Also, click follow on the side to subscribe and feel free to pass this onto somebody who you believe will benefit from re-gaining their strength, small steps at a time.

Usually when you talk about cancer, or hear about somebody being diagnosed with cancer, we are instantly jumping to negative thoughts. However, we often miss the rest of the cup, the cup that can be half full if we wish it to be – the cup can even be three quarters full if we wanted it to be!

Today I will speak of my encounter with Helene O’Neill. Helene is definitely a glass is three-quarters full kind of woman. A few weeks ago I presented my research at the Australia and New Zealand Gynaecological Oncology Group (ANZGOG) annual scientific meeting in Canberra, Australia – a meeting for the latest in women’s cancer research. It was a great day with some amazing oncologists presenting their research, interesting debates but also an initiative to have volunteers who assist with patient support groups enlighten us of their experiences. This is powerful because at the end of the day, I, along with others have passion for the health industry to help each individual person.

Now Helene, a Uterine cancer survivor, did not sound like anything could get her down, and would rather take life by the horns. She spoke with such confidence and pride. She had strength that needed to be witnessed, as she is an inspiration for cancer survivors around the country, and this is evident with her passion for exercise and the community work she does with ANZGOG. I needed to find out more from her and her story, to share it, and assist in inspiring and motivating others so I asked her a few more questions….

Helene was diagnosed in 2007 around the same time her hometown of Newcastle flooded, which included her house. Her mother-in-law also passed away around the same time so it was a particularly sensitive period to say the least. Her oncologist, Dr Geoff Otton removed a grapefruit-sized tumour from her, performed a hysterectomy and removed lymph nodes, but she did not require radiation therapy.

(above – The 2007 Newcastle floods were not going to hold Helene back)

I asked Helene how she felt physically and emotionally right after her treatment. She said “I was extremely tired in the early part and did suffer a loss of confidence with things like exercise”, which is completely understandable, right? “My bike is my friend and I remember the first time I went for a ride after the operation – a trip that normally takes 10 mins took me 30 mins – I was paranoid !! My quality of life was affected as the fear of lymphedema scared me but I attended a clinic and learnt a lot about the condition so I could get on with life.”

So the tasks usually simple to Helene were suddenly much more of a challenge, and that is where it is important to take the necessary steps to regain your fitness, be inspired and get back your lease on life. Helene was always healthy and physically active and her cancer diagnosis was not going to stop her. At first she feared she may have to stop exercising, but put that behind her as being active made her feel healthy and happy.

(above – Helene getting back on the bike)

The self-proclaimed “super-competitive” former gym instructor is keen to try any form of exercise. Happy to avoid gyms, Helene likes to run, row, ride bikes and swim. She also enjoys sports – tennis, badminton and coaching soccer! Now, I thought I was super-sporty, but she is giving me a run for my money!!

I asked what a typical week of exercise looked like for her just to put into perspective:

(above – for those who don’t know paddle skiing, it is a water sport requiring a great amount of core abdominal strength, and is also very fun!)

I’ve spent much time talking in previous posts of the benefits of exercise in scientific research, but what also matters is how each individual feels. So how does being active make Helene feel? “I love the adrenalin rush. I also know that exercise is one aspect of my life that I am in control of. I like to exercise on my own so I can vary the activity, the pace and the duration and use the time to get to know myself better.” She is in the minority of people who requires little encouragement to exercise, so she definitely doesn’t need me running around telling her she is doing a great job, considering she has been a representative sports athlete since she was 5 years old. Even sometimes her husband tells her to slow down, as she “refuses to let age and health get in her way“. Amazing!

However, it is not without its challenges, the risk of lymphedema and infection remain a possibility, but she is willing to meet those challenges head on.

Now as an ambassador for ANZGOG and to patients in rural areas, I asked Helene if she could provide a few words of inspiration to survivors who may be newly diagnosed or struggle for motivation. I often think these words are way more powerful from somebody who has had these experiences and bounced back, rather than a health professional like myself, who cannot speak of cancer first-hand – and this is what she said:

“Support comes in many forms but the one person I can rely on is myself. I encourage patients to steer away from the excuses, listen to their body and view exercise as one of the means to get well. There’s the adage ‘that cancer isn’t a sentence’. Basically it’s an opportunity to discover a ‘new’ you. Whilst everyone has a different cancer trip, it’s better to live in the present and enjoy every day to the max. I love to share my story – not the cancer journey – but the day-to-day highlights that I enjoy. Sure you reflect on the past but that’s not going to change – live in the peace of the moment. On your bike !!!”

I really hope you have found Helene’s story inspirational, as I have. Pass this story to somebody who you care about, a friend or a family member who can benefit from the support. Share on Facebook or Twitter to keep growing a community. Follow this blog for more posts, provide any comments or questions, join an e-mail list and like me on Twitter. Any questions, feel free to get in touch as well by e-mail.

Every two years sees the national Exercise & Sports Science Australia (ESSA) conference held, which brings together about a thousand researchers, clinicians, academics and some amazing presenters to discuss the latest in physical activity research, clinical guidelines and the opportunity to collaborate and bring forward great ideas to move the field forward and create the best possible outcomes for our patients.

The highlights of this conference for me were:

* Prof Daniel Green – why exercise is better for the cardiovascular system than we first believed

These talks were inspirational and I managed to learn some great information. However, this conference was also more special for me as I was fortunate enough to present my research on exercise for women with advanced ovarian cancer.

It was a great environment to discuss my findings, in which these patients who were undergoing chemotherapy who exercised for more than 90 minutes/week had reduced fatigue, slept better, improved quality of life, were stronger and had less anxiety.

I also had a poster viewing session, which was a great way to interact with other researchers. Here I met an expert in chronic pain, Matthew Jones, and he was able to give me insight into how he helps to reduce pain by exercising in young healthy people, something of massive interest we seek to investigate in the future for cancer survivors.

I also managed to attend some great presentations of colleagues and experts in the field:

Dr Fiona Naumann (above) spoke on the complex considerations for exercise physiologists working with cancer survivors, Carolina Sandler gave great insight to the Post-Cancer Fatigue experienced by survivors, and how exercise therapy can help manage this, whilst Simon Rosenbaum discussed his research improving the mental health issues for patients with Post Traumatic Stress Disorder.

In terms of cancer & exercise research, there was also other great talks on reducing side-effects of Prostate cancer treatment by Brad Wall and Tina Skinner, and a pre-surgery exercise program by Andrew Murnane. Anna Meares OAM, olympic medalist for cycling also presented her amazing story of recovering from a fractured neck vertibrae only to return and win a silver medal at the London games.

Overall, it was a fantastic few days – and to top it off, I was very surprised and honoured to be awarded a research award for my work.

Check out the Twitter feed for the ESSA conference #ESSA14

Now, I return to Sydney with a whole range of new ideas, more potential researchers to do further work with as I set the bar high with what we can achieve and assist as many future survivors as we can.

Please add me on twitter, ask questions, share our quest with other survivors, follow and most of all, just get out there and get active! We are here to help!

So at the half way point of the weekly walking challenge that we have set for ourselves today, think to yourself if you are happy with your progress, and what will you achieve for both a) the rest of the week and b) next week.

The general recommendation by the American Cancer Society and American College of Sports Medicine is 150 minutes/week – so 30 mins x 5 days a week is common.

Can you make time to go for 2x walks over the weekend?

Here are some handy tips:

* plan the day before for when you will exercise

* go for morning walks, to avoid procrastination of leaving it until the afternoon

* take a friend/family member with and make it social

* get a pedometer and measure step count (aiming for 10,000 steps/day)

* get on/off the bus 2-3 stops early and walk to the stop

Keep a tally of how many minutes you achieve each session and per week, write it on a piece of paper and stick it on the fridge as a reminder/motivator. Every week your goal is to maintain or increase the amount.

You can do it! Get out there, feel good, be strong, live life, be empowered, be positive!

Welcome everybody today, I hope this blog has been helpful in inspiring and motivating people throughout their journeys to take that step and engage in healthy lifestyles.

I would firstly like to say that today is an important day for me, I have just submitted my thesis on my previous 2 years of work with the ovarian cancer ladies in Sydney, so I am a very happy camper! But that will not stop me writing!

So I am feeling good and celebrated with a gym weights session, an indoor soccer match and a yum home-cooked dinner.

I would like put forward to everyone here, a weekly exercise challenge.Now I must stress here, I cannot give specific targets to individuals without having a good chat with you, but I can provide general recommendations, such as the ones released by the American Cancer Society below:

Moderate intensity = heart rate/breathing rate increases so having a conversation is challenging

Lets aim for moderate intensity. 150 minutes we can break up throughout the week, so we are generally looking at 30 minute walks on 5 days per week. But if its been a while since you’ve gone out there, try 10-15 minute sessions first and build up. You can do it.

Now to keep you accountable, keep an activity diary and fill it in daily like the one below:

Simple. So you can plan and try a match/beat your previous weeks. I did this with the women in my study and once in a nice routine, they could increase their programs and make it more challenging.

Give it a week and see how you go, aim for that 150 for the week. Here’s how mine may look for the week

Mon – indoor soccer pm (40 min)

Tues – gym weights (40 min)

Wed – run/cycle (30-40 min)

Thurs – gym weights (40 min)

Fri – rest

Sat – rest (or light jog on Bondi Beach)

Sun – Soccer match – 90 mins

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Now I do play a fair amount of sport, but a goal of mine – and a goal of YOURS is to AVOID inactivity. try avoid having too many days in the week with no exercise, even small walks are beneficial to how you may start to feel.

As a reminder, here are some of the possible benefits from partaking in regular exercise from the American Cancer Society:

Get out there, small walks at a time and build up.

Now please get back to me with how you went as it would be great to encourage other survivors with your efforts! (comments or e-mails!)

As always, please share this with a loved one, or encourage a friend to walk, or like this page and tell yourself you can do it – because you can!

Thanks for the overwhelming response in readership I have received over the past few weeks from all around the world, it is great that there is growing interest in taking charge and moving forward after diagnosis. I would like to use this post to try and get the word out, to share some lifestyle tips and provide encouragement to those who have been affected by cancer. My previous posts have highlighted that exercise is safe and provides numerous evidence-based benefits during various treatment types and after treatment.

Today, I would like all of my readers to share this blog with somebody they know – a friend, a family member, a work colleague, through Facebook, Twitter, email or word of mouth, who has had somebody in their lives (as so many of us have) affected by cancer. I want them to know that they are not alone in their journey, that there are many people, including myself, a complete stranger, who is willing to help improve their quality of life.

By connecting the community, we can share each others stories, experiences, challenges and triumphs – and that can be valuable to encourage people. I wish to gain peoples stories from diagnosis and thereafter, including how they began to exercise, what routines they got in, their likes/dislikes etc. so people who come along earlier into their journey can have some inspiration.

In the chemotherapy suits last year at Prince of Wales Hospital, Sydney, one of my patients who I had trained, was telling other ladies with ovarian cancer in the clinic how she had built up over the previous 6 months and was attempting her first City2Surf run (14km charity run). I was so impressed with her, she was so proud of herself. Although she stopped halfway for a coffee to enjoy the beautiful Sydney harbour views, it was a most amazing accomplishment.

Recruitment for my study went through the roof after that. Women were asking around the clinics to sign up, it was a great advertisement for living a healthy lifestyle, despite undergoing chemotherapy every week, and an example of a great supportive network.

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It is this power that I want to use by connecting people so we can share stories, read stories, have the inspiration to try go for a long walk, to have the inspiration to try and jog on the beach, to be inspired to go to a yoga class or a gym class, to ask my doctor what exercise services are on offer.

Please follow and share this with somebody who can benefit, who can re-gain strength and get more out of life, and feel free to get in touch with any questions, comments or stories you may have.

It has been a few crazy weeks since i’ve posted after spending many late nights trying to finish my thesis, as well as putting together presentations for conferences around Australia coming up, but I have found time as I really wanted to promote an article I read in the Journal of Clinical Oncology that was published this year titled:

Now, I personally do not engage regularly in yoga – I have on occasion and really enjoyed it, and really do promote it to women, people with back issues or core-stability weakness and those who like a group environment. Not only is it relaxing, there are emerging benefits coming from scientific research which is great.

This study made women partake in Hatha yoga for 2x 90 minute sessions per week for 12 weeks. This is a fair amount to partake in, and a realistic place to start an exercise program.

Here were the benefits: Reduced fatigue, increased vitality as well as a range of blood-markers associated with fatigue and inflammation (IL6, TNFa).

Thats pretty impressive!

By partaking in regular yoga, you can allow yourself to feel better, have more energy, get out there in the world, live life again, take control, be who you want to be!

If you are considering getting back to your old yoga classes or starting a new one, dont try and rush to complete the most complex stretches straight away. Ease into things at a basic level for the first couple of weeks. Once your body is comfortable, then you can start to challenge yourself.

2013 was a big year for me. I managed to present my research involving ovarian cancer patients at 3 conferences, I spoke at 5 different hospitals in Sydney as well as 3 patient support groups. I am 100% happy to put my work aside so I can take these opportunities, as it is very important for patients, clinicians, families, nurses and the general public to be aware of how something as simple as walking can actually help a cancer patient.

The year started off with a trip to Adelaide, Australia for the Flinders Centre for Innovation in Cancer Survivorship conference. This was a great opportunity and and interesting mix. Half of the delegates were medicos (doctors, nurses, allied health staff) whilst the other half were cancer survivors/patients/advocates – So all in all it was a really nice dynamic. This was my first conference presenting this research, so naturally I was a little bit nervous. The main points of the poster above were:

* ovarian cancer patients undergoing chemo were asked to achieve 90+ mins/week of exercise for 12 weeks – They could do it!

* Their sleep improved

* Their fatigue reduced

* Their quality of life increased

* Their muscular strength increased

I actually got some great exposure from this conference. I had oncologists from around Australia asking me what they should be encouraging their patients to do, and also some amazing cancer survivors telling me of their experiences with trying to remain active. I simply encouraged them, keep up what you are doing and every week try and out-do what you did last week. “A little bit longer in duration, a little bit higher in intensity and you will reap the benefits.”

Next stop – Liverpool, United Kingdom – the home of the Beatles, Liverpool or Everton Football Club (depending who you are speaking to), lack of sun and many a pub.

The European Society of Gynaecological Oncology Conference. What an experience this was. Over 3000 medical folk, a handful of Australians, in which I did not know any and a lot of great research presentations from top European doctors. This conference was interesting for me, as the majority of topics were related to drug or surgical administration, and minimal on complementary medicines such as exercise, diet or psychological interventions – which are all extremely valuable to the well-being of each patient. This was a good thing for me, as my work was more unique, and again I had decent interest from people around the world. So many European doctors were telling me they didnt have the funds to employ an exercise physiologist or a physiotherapist in their hospitals. My response – educate the patient on the importance on remaining active during and after treatment. They will listen to you. That is it, a couple of sentences will provide encouragement.

(my abstract at the bottom underneath all the very complex medical trials)

In this conference I spoke about the relationship between physical activity and sleep quality for ovarian cancer patients undergoing chemo. Firstly, they dont sleep well at all. So i monitored them with this high tech GPS device to track their sleep quality for a week. Turns out, of the participants who were more active than the others, they actually slept better. This is important because more sleep -> less fatigue -> more energy -> less anxiety -> higher quality of life = good news.

However, it was a great experience and a lot of hard work. Hard work means hard play – so naturally, being on the other side of the world, I thought it was only fair I could have some down time

Back on a long plane ride to Sydney (26 hrs) and straight to Adelaide again for the Clinical Oncology Society of Australia conference.

Now this picture was taken of me in front of my poster during the networking function, in which a couple of glasses of wine were consumed compounded with my jetlag from the UK and I guess I was just being silly.

Nonetheless, this was another great conference for me. This time I spoke about what were the reasons holding patients back from exercising – the barriers. In a nutshell, the main reason for not exercising for fatigue. Now, I get that. But when there is evidence showing engaging in exercise will reduce your fatigue, you would wish to give it a go. The patients who were exercising more in this study, reported less fatigue again. A trend appears to be going on. Other reasons for not exercising was that it was not a priority and procrastination was an issue. If you have read my previous articles showing exercise can increase life expectancy, reduce recurrence risk and improve countless symptoms, I think it IS a priority and I dont think procrastination should be a word in your vocabulary anymore.

These were amazing experiences. Now i set up 2014 with a more meetings, conferences and patient support group talks ahead of me, I am full of excitement for what this year has to come. If I have an audience of 1 person or 150 people, it does not matter to me, as long as the message gets through. You can do it, one step at a time.